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Rizzo JF, Shah MP, Krasniqi D, Lu YR, Sinclair DA, Ksander BR. The Role of Epigenetics in Accelerated Aging: A Reconsideration of Later-Life Visual Loss After Early Optic Neuropathy. J Neuroophthalmol 2024; 44:16-21. [PMID: 37938114 DOI: 10.1097/wno.0000000000002041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND In 2005, we reported 3 patients with bilateral optic nerve damage early in life. These patients had stable vision for decades but then experienced significant bilateral vision loss with no obvious cause. Our hypothesis, novel at that time, was that the late decline of vision was due to age-related attrition of retinal ganglion cells superimposed on a reduced neuronal population due to the earlier injury. EVIDENCE ACQUISITION The field of epigenetics provides a new paradigm with which to consider the normal aging process and the impact of neuronal injury, which has been shown to accelerate aging. Late-in-life decline in function after early neuronal injury occurs in multiple sclerosis due to dysregulated inflammation and postpolio syndrome. Recent studies by our group in mice have also demonstrated the possibility of partial reversal of cellular aging and the potential to mitigate anatomical damage after injury and even improve visual function. RESULTS The results in mice and nonhuman primates published elsewhere have shown enhanced neuronal survival and visual function after partial epigenetic reprogramming. CONCLUSIONS Injury promotes epigenetic aging , and this finding can be observed in several clinically relevant scenarios. An understanding of the epigenetic mechanisms at play opens the opportunity to restore function in the nervous system and elsewhere with cellular rejuvenation therapies. Our earlier cases exemplify how reconsideration of previously established concepts can motivate inquiry of new paradigms.
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Affiliation(s)
- Joseph F Rizzo
- Department of Ophthalmology and the Neuro-Ophthalmology Service (JFR), Massachusetts Eye and Ear and the Harvard Medical School, Boston, Massachusetts; Avedisian and Chobanian School of Medicine (MPS), Boston University, Boston, Massachusetts; Department of Ophthalmology (MPS, DK, BRK), Harvard Medical School, Schepens Eye Research Institute of Mass Eye & Ear, Boston, Massachusetts; Department of Biology (YRL), Whitehead Institute for Biomedical Sciences, MIT, Cambridge, Massachusetts; and Paul F. Glenn Center for Biology of Aging Research (DAS), Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts
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Moon Y, Park KA, Han J, Hwang JM, Kim SJ, Han SH, Lee BJ, Kang MC, Goh YH, Lim BC, Yang HK, Jung JH. Risk of central nervous system demyelinating attack or optic neuritis recurrence after pediatric optic neuritis in Korea. Neurol Sci 2024; 45:1173-1183. [PMID: 37853292 DOI: 10.1007/s10072-023-07125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To investigate the rate of development of symptomatic central nervous system (CNS) demyelinating attacks or recurrent optic neuritis (ON) after the first episode of ON and its risk factors for Korean pediatric patients. METHODS This multicenter retrospective cohort study included the patients under 18 years of age (n=132) diagnosed with ON without previous or simultaneous CNS demyelinating diseases. We obtained the clinical data including the results of neuro-ophthalmological examinations, magnetic resonance images (MRIs), antibody assays, and laboratory tests. We investigated the chronological course of demyelinating disease with respect to the occurrence of neurological symptoms and/or signs, and calculated the 5-year cumulative probability of CNS demyelinating disease or ON recurrence. RESULTS: During the follow-up period (63.1±46.7 months), 18 patients had experienced other CNS demyelinating attacks, and the 5-year cumulative probability was 14.0±3.6%. Involvement of the extraorbital optic nerve or optic chiasm and asymptomatic lesions on the brain or spinal MRI at initial presentation were significant predictors for CNS demyelinating attack after the first ON. The 5-year cumulative probability of CNS demyelinating attack was 44.4 ± 24.8% in the AQP4-IgG group, 26.2±11.4% in the MOG-IgG group, and 8.7±5.9% in the double-negative group (P=0.416). Thirty-two patients had experienced a recurrence of ON, and the 5-year cumulative probability was 24.6±4.0%. In the AQP4-IgG group, the 5-year cumulative probability was 83.3±15.2%, which was significantly higher than in the other groups (P<0.001). CONCLUSIONS A careful and multidisciplinary approach including brain/spinal imaging and antibody assay can help predict further demyelinating attacks in pediatric ON patients.
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Affiliation(s)
- Yeji Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jinu Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul, 03080, South Korea
| | - Sueng-Han Han
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min Chae Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Hyu Goh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul, 03080, South Korea.
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Characteristics of Optic Neuritis in South Korean Children and Adolescents: A Retrospective Multicenter Study. J Ophthalmol 2022; 2022:4281772. [PMID: 36119139 PMCID: PMC9473900 DOI: 10.1155/2022/4281772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To analyze the clinical characteristics and prognosis of optic neuritis (ON) in pediatric patients aged <19 years in South Korea. Methods This multicenter retrospective cohort study included 127 pediatric patients (median age: 10.3 (IQR: 7.3–14.2) years; female, 62.2%) who experienced ON for the first time between January 2004 and January 2018, with data obtained from five tertiary university-based hospitals in Korea. When ON was bilateral, the worse eye was selected for analysis. The baseline clinical characteristics and prognoses of patients, as well as the associations between these parameters, were analyzed. Results The baseline clinical characteristics of the patients were as follows: best-corrected visual acuity (BCVA) < 20/200, 65.9%; pain on eye movement, 47.2%; optic disc swelling, 66.9%; and bilateral involvement, 41.7%. Among 101 patients who were followed up for ≥6 months, 48 (47.5%), 12 (11.9%), 19 (18.8%), 13 (12.9%), and 9 (8.9%) had been diagnosed with isolated ON, recurrent ON, multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and acute disseminated encephalomyelitis (ADEM)-related ON, respectively. At the latest visit, 81.9% and 71.1% had achieved BCVA of ≥20/40 and ≥ 20/25, respectively. Only disc swelling at presentation was associated with poor baseline BCVA (coefficient: 0.31, P=0.004) and greater improvement in BCVA (coefficient: 0.49, P = 0.001P=0.001); there were no significant associations between the baseline factors and final BCVA. Conclusions This study demonstrated pediatric ON-related clinical characteristics and visual outcomes in South Korea. Within this cohort, in about 40.6% of patients, ON was associated with other demyelinating diseases, namely, MS, NMOSD, and ADEM.
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Gupta V, Luthra S, Maheshwari S, Das SM. Relapsing neuromyelitis optica in an adolescent girl. BMJ Case Rep 2021; 14:e242402. [PMID: 34426420 PMCID: PMC8383875 DOI: 10.1136/bcr-2021-242402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/03/2022] Open
Abstract
Early differentiation of neuromyelitis optica spectrum disorder (NMO-SD) from multiple sclerosis (MS) is of paramount importance as NMO-SD (especially relapsing variant) has more severe morbidity than MS. We describe a case of an adolescent girl who presented with repeated episodes of optic neuritis over a period of 4 years with normal brain MRI scans. She was treated initially as relapsing remitting MS, before showing clinical evidence of transverse myelitis (TM), and eventually being diagnosed as NMO-SD. Pulse intravenous methyl prednisolone along with immunosuppressive therapy led to remission of her disease. However, delay in diagnosis as NMO-SD led to visual disability in the left eye. Therefore, in young patients with recurrent optic neuritis and normal brain MRI, it may be prudent to get spinal MRI done to look for TM, even when asymptomatic. In addition, we should keep a low threshold for requesting aquaporin-4 antibody testing in these patients.
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Affiliation(s)
- Vinita Gupta
- Ophthalmology, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Saurabh Luthra
- Ophthalmology, Drishti Eye Institute, Dehradun, Uttarakhand, India
| | - Shrey Maheshwari
- Ophthalmology, Drishti Eye Institute, Dehradun, Uttarakhand, India
| | - Shrutanjoy M Das
- Ophthalmology, Drishti Eye Institute, Dehradun, Uttarakhand, India
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Monge Galindo L, Martínez de Morentín A, Pueyo Royo V, García Iñiguez J, Sánchez Marco S, López-Pisón J, Peña-Segura J. Optic neuritis in paediatric patients: experience over 27 years and a management protocol. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pineles SL, Repka MX, Liu GT, Waldman AT, Borchert MS, Khanna S, Heidary G, Graves JS, Shah VS, Kupersmith MJ, Kraker RT, Wallace DK, Cotter SA, Holmes JM. Assessment of Pediatric Optic Neuritis Visual Acuity Outcomes at 6 Months. JAMA Ophthalmol 2020; 138:1253-1261. [PMID: 33057592 PMCID: PMC7563662 DOI: 10.1001/jamaophthalmol.2020.4231] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/31/2020] [Indexed: 01/10/2023]
Abstract
Importance Optic neuritis (ON) in children is uncommon. There are limited prospective data for visual acuity (VA) outcomes, associated diseases, and neuroimaging findings. Prospective data from a large sample would be useful for counseling families on treatment decisions and prognosis. Objective To prospectively study children with a first episode of ON, describe VA after 6 months, and ascertain the network's (Pediatric Eye Disease Investigator Group and Neuro-Ophthalmology Research Disease Investigator Consortium) ability to enroll pediatric patients with ON prospectively. Design, Setting, and Participants This nonrandomized cohort study was conducted from September 20, 2016, to July 20, 2018, at 23 sites in the United States and Canada in pediatric ophthalmology or neuro-ophthalmology clinics. A total of 44 children (aged 3-15 years) presented with a first episode of ON (visual loss, pain on eye movements, or both) within 2 weeks of symptom onset and at least 1 of the following in the affected eye: a distance high-contrast VA (HCVA) deficit of at least 0.2 logMAR below age-based norms, diminished color vision, abnormal visual field, or optic disc swelling. Exclusion criteria included preexisting ocular abnormalities or a previous episode of ON. Main Outcomes and Measures Primary outcomes were monocular HCVA and low-contrast VA at 6 months. Secondary outcomes were neuroimaging, associated diagnoses, and antibodies for neuromyelitis optica and myelin oligodendrocyte glycoprotein. Results A total of 44 children (mean age [SD], 10.2 [3.5] years; 26 boys [59%]; 23 White individuals [52%]; 54 eyes) were enrolled in the study. Sixteen patients (36%) had bilateral ON. Magnetic resonance imaging revealed white matter lesions in 23 children (52%). Of these children, 8 had myelin oligodendrocyte glycoprotein-associated demyelination (18%), 7 had acute disseminated encephalomyelitis (16%), 5 had multiple sclerosis (11%), and 3 had neuromyelitis optica (7%). The baseline mean HCVA was 0.95 logMAR (20/200), which improved by a mean 0.76 logMAR (95% CI, 0.54-0.99; range, -0.70 to 1.80) to 0.12 logMAR (20/25) at 6 months. The baseline mean distance low-contrast VA was 1.49 logMAR (20/640) and improved by a mean 0.72 logMAR (95% CI, 0.54-0.89; range, -0.20 to 1.50) to 0.73 logMAR (20/100) at 6 months. Baseline HCVA was worse in younger participants (aged <10 years) with associated neurologic autoimmune diagnoses, white matter lesions, and in those of non-White race and non-Hispanic ethnicity. The data did not suggest a statistically significant association between baseline factors and improvement in HCVA. Conclusions and Relevance The study network did not reach its targeted enrollment of 100 pediatric patients with ON over 2 years. This indicates that future treatment trials may need to use different inclusion criteria or plan a longer enrollment period to account for the rarity of the disease. Despite poor VA at presentation, most children had marked improvement by 6 months. Associated neurologic autoimmune diagnoses were common. These findings can be used to counsel families about the disease.
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Affiliation(s)
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Grant T Liu
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amy T Waldman
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Sangeeta Khanna
- Department of Ophthalmology and Neurology, St Louis University, St Louis, Missouri
| | - Gena Heidary
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - David K Wallace
- Glick Eye Institute, Indiana University School of Medicine, Indianapolis
| | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
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Chhabda S, Malik P, Reddy N, Muthusamy K, Mirsky D, Sudhakar S, Mankad K. Relapsing Demyelinating Syndromes in Children: A Practical Review of Neuroradiological Mimics. Front Neurol 2020; 11:627. [PMID: 32849169 PMCID: PMC7417677 DOI: 10.3389/fneur.2020.00627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/28/2020] [Indexed: 01/02/2023] Open
Abstract
Relapsing demyelinating syndromes (RDS) in children encompass a diverse spectrum of entities including multiple sclerosis (MS) acute disseminated encephalomyelitis (ADEM), aquaporin-4 antibody associated neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOG-AD). In addition to these, there are “antibody-negative” demyelinating syndromes which are yet to be fully characterized and defined. The paucity of specific biomarkers and overlap in clinical presentations makes the distinction between these disease entities difficult at initial presentation and, as such, there is a heavy reliance on magnetic resonance imaging (MRI) findings to satisfy the criteria for treatment initiation and optimization. Misdiagnosis is not uncommon and is usually related to the inaccurate application of criteria or failure to identify potential clinical and radiological mimics. It is also notable that there are instances where AQP4 and MOG antibody testing may be falsely negative during initial clinical episodes, further complicating the issue. This article illustrates the typical clinico-radiological phenotypes associated with the known pediatric RDS at presentation and describes the neuroimaging mimics of these using a pattern-based approach in the brain, optic nerves, and spinal cord. Practical guidance on key distinguishing features in the form of clinical and radiological red flags are incorporated. A subsection on clinical mimics with characteristic imaging patterns that assist in establishing alternative diagnoses is also included.
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Affiliation(s)
- Sahil Chhabda
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom
| | - Prateek Malik
- Christian Medical College & Hospital, Vellore, India
| | | | | | - David Mirsky
- Children's Hospital Colorado, Aurora, CO, United States
| | - Sniya Sudhakar
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom.,Associate Honorary Professor, Institute of Child Health, University College London, London, United Kingdom
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Tonagel F, Wilhelm H, Kelbsch C. Optic neuritis in German children: clinical findings and association with multiple sclerosis. Graefes Arch Clin Exp Ophthalmol 2020; 258:1523-1526. [PMID: 32274587 PMCID: PMC8349338 DOI: 10.1007/s00417-020-04669-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/12/2020] [Accepted: 03/27/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose Analysis of a cohort of pediatric optic neuritis patients concerning the epidemiology, disease progression, and association with multiple sclerosis (MS). Methods Retrospective, observational cohort study. From 2004 to 2018, all electronic medical files of patients younger than 18 years referred to a tertiary care clinic in Germany with the diagnosis optic neuritis have been analyzed. Results Sixty-nine patients were referred in the study period, 16 did not suffer under optic neuritis and were excluded. The median visual acuity of the remaining 53 patients was 0.07 at the baseline examination and 1.0 at the latest follow-up examination (decimal notation, median 2.1 years after baseline). Forty-two percent of the patients developed MS during the study period. Female sex (p = 0.028) as well as higher age (p = 0.0082) proved to be statistically significant risk factors for MS development. Conclusion The prognosis for restoring vision in pediatric optic neuritis was favorable. During the observation period, the risk of developing MS was overall 42% and 8% for patients younger than 11 years. The percentage of MS as underlying cause of optic neuritis does not differ remarkably between children older 10 years and adults.
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Affiliation(s)
- Felix Tonagel
- Centre for Ophthalmology, University of Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany.
| | - Helmut Wilhelm
- Centre for Ophthalmology, University of Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Carina Kelbsch
- Centre for Ophthalmology, University of Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
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Visual Outcomes and Clinical Manifestations of Pediatric Optic Neuritis in Indian Population: An Institutional Study. J Neuroophthalmol 2020; 38:462-465. [PMID: 29554001 DOI: 10.1097/wno.0000000000000646] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optic neuritis in children is an uncommon disorder which usually occurs after a viral illness or vaccination and, less frequently, occurs as a manifestation of a demyelinating disorder. Pediatric optic neuritis usually is bilateral and presents with optic disc edema, recovers rapidly with steroid therapy, and generally has low conversion rate to multiple sclerosis or neuromyelitis optica spectrum disorder. We report the clinical features and treatment outcomes of pediatric optic neuritis in Indian population, for which little data are available. METHODS We reviewed the medical case records of patients with optic neuritis who were younger than 18 years, from 1999 to 2016. All patients were assessed and managed in the Neuro-Ophthalmology Department of Sankara Nethralaya, a unit of Medical Research Foundation and Pediatric Neurology Department of Kanchi Kamakoti-Childs Trust Hospital, Chennai, India. RESULTS One hundred seventeen eyes of 78 children with mean age of 11.84 (±4.58) years were identified. Forty-two (53.8%) were females and 36 (46.2%) were males. Thirty-nine patients (50%) had bilateral involvement and a similar number had unilateral involvement. Fifty-nine eyes (50.4%) had optic disc edema, 20 eyes (17.1%) had disc pallor, and 38 eyes (32.4%) had normal discs. Of 63 patients who had neuroimaging, 36 had MRI, and 27 underwent computed tomography. Eighty-four eyes (of 59 patients) received steroid therapy according to the protocol of the Optic Neuritis Treatment Trial (ONTT). Thirty-three eyes that were treated with other steroid protocols were excluded from the final visual outcome analyses. Sixty of the 84 eyes (72.3%) recovered visual acuity of 20/40 or better. Visual acuity improvement was statistically significant between initial and final visual acuity (logMAR) in our patients treated with the ONTT protocol (P ≤ 0.001). CONCLUSIONS Our Indian pediatric population had good visual recovery after steroid treatment for optic neuritis. Profound loss of visual acuity on presentation and bilateral involvement were significantly associated with poor visual outcome.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on advances in the understanding of pediatric demyelinating optic neuritis. RECENT FINDINGS In the past decade, the disease phenotypes for demyelinating syndromes in children have been more clearly defined. Pediatric optic neuritis may present as a clinically isolated syndrome or in the setting of underlying neurologic disease. In addition to optic neuritis associated with multiple sclerosis or neuromyelitis optica, recent work has identified antibodies to the myelin oligodendrocyte glycoprotein (MOG IgG) as a unique demyelinating cause with distinct features regarding treatment and prognosis. The disease phenotypes for demyelinating pediatric optic neuritis have expanded. Treatment strategies vary and are not universally effective for each cause of demyelinating disease. Accurately distinguishing among these unique clinical syndromes is therefore critical for initiation of appropriate treatment to prevent disability, to maximize visual outcomes, and to provide insight into long-term prognosis.
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Affiliation(s)
- Ryan A Gise
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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Jonzzon S, Suleiman L, Yousef A, Young B, Hart J, Peschl P, Reindl M, Schaller KL, Bennett JL, Waubant E, Graves JS. Clinical Features and Outcomes of Pediatric Monophasic and Recurrent Idiopathic Optic Neuritis. J Child Neurol 2020; 35:77-83. [PMID: 31566057 PMCID: PMC7018758 DOI: 10.1177/0883073819877334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Limited data exist on isolated optic neuritis in children. We report the clinical features and treatment of pediatric subjects with monophasic and recurrent idiopathic optic neuritis. This retrospective cohort study of patients with isolated optic neuritis identified 10 monophasic and 7 recurrent optic neuritis cases. Monophasic optic neuritis patients were older (mean 13.3 ± 4.22) than those with recurrent idiopathic optic neuritis (9.86 ± 3.63). Females represented 50% of monophasic and 85.7% of recurrent idiopathic optic neuritis cases. Patients with monophasic optic neuritis were less likely to have a bilateral onset than recurrent idiopathic optic neuritis (40% vs 57.1%). Only 1 case had oligoclonal bands in the cerebrospinal fluid CSF. Most recurrent idiopathic optic neuritis cases had evidence of anti-myelin oligodendrocyte glycoprotein (MOG) antibodies (5/7). Treatment of recurrent idiopathic optic neuritis cases included intravenous pulse glucocorticosteroids and immunotherapy. We observed differences between recurrent and monophasic idiopathic optic neuritis. Immunosuppression appeared to prevent further relapses in recurrent idiopathic optic neuritis patients. Weaning immunotherapies after several years of quiescence in recurrent idiopathic optic neuritis may be possible, but larger studies are needed.
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Affiliation(s)
- Soren Jonzzon
- Medical School of the University of California, San Francisco, CA, USA
| | - Leena Suleiman
- Medical School of the University of California, San Francisco, CA, USA
| | - Andrew Yousef
- Medical School of the University of California, San Francisco, CA, USA
| | - Brenda Young
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Janace Hart
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Patrick Peschl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kristin L. Schaller
- Department of Neurology, Program in Neuroscience, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jeffrey L. Bennett
- Department of Ophthalmology, Program in Neuroscience, University of Colorado School of Medicine, Aurora, CO, USA
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Jennifer S. Graves
- Department of Neurology, University of California, San Francisco, CA, USA,Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
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Wilbur C, Reginald YA, Longoni G, Grover SA, Wong AM, Mabbott DJ, Arnold DL, Marrie RA, Bar-Or A, Banwell B, Costello F, Yeh EA. Early neuroaxonal injury is seen in the acute phase of pediatric optic neuritis. Mult Scler Relat Disord 2019; 36:101387. [DOI: 10.1016/j.msard.2019.101387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 01/18/2023]
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Lee JY, Han J, Yang M, Oh SY. Population-based Incidence of Pediatric and Adult Optic Neuritis and the Risk of Multiple Sclerosis. Ophthalmology 2019; 127:417-425. [PMID: 31732227 DOI: 10.1016/j.ophtha.2019.09.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/09/2019] [Accepted: 09/19/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine the age- and sex-specific prevalence and incidence of demyelinating optic neuritis and the risk of multiple sclerosis (MS) in pediatric and adult populations in South Korea. DESIGN A nationwide, population-based, retrospective study using data from the Korean National Health Claims database from 2010 to 2016. PARTICIPANTS The entire South Korean population aged 65 years of age or younger (n = 44 700 564). All patients with optic neuritis from the entire Korean population were included. METHODS Patients aged 14 years of age or younger were classified as pediatric patients, and those aged 15 to 65 years were classified as adults. Each group was analyzed separately. Patients with optic neuritis had a subsequent diagnosis, including idiopathic, MS, neuromyelitis optica (NMO), and acute disseminated encephalomyelitis. Prevalence and incidence, conversion rate to MS, and treatment modalities (steroids, plasmapheresis, interferon-β, and immunosuppressants) were estimated. MAIN OUTCOME MEASURES Prevalence and incidence of optic neuritis, and conversion rate to MS. RESULTS Among 44 700 564 individuals, 531 pediatric patients (50.7% female) and 7183 adults (53.3% female) were identified as having optic neuritis. Annual incidence was 1.04 (95% confidence interval [CI], 1.01-1.07) per 100 000 pediatric individuals and 3.29 (95% CI, 3.28-3.30) per 100 000 adults. Peak incidence was observed at 10 to 14 years in the pediatric population and at 30 to 34 years and 50 to 54 years in the adult population. Conversion rate to MS was 13.8% in the pediatric population and 11.4% in the adult population. Fourteen percent of all patients were treated with chronic immunosuppressants, 38% of patients with NMO underwent plasmapheresis, and 50% of patients with MS were treated with interferon-β. CONCLUSIONS This is a nationwide epidemiologic study of optic neuritis in individuals of all ages in South Korea. The incidence of optic neuritis and subsequent risk of MS in the pediatric population are comparable to those reported in western countries but are lower in the adult population than in western countries. The incidence rate in adults was 3.2-fold higher than in the pediatric population, and the overall MS conversion rate in the entire Korean population was estimated to be 10.6%.
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Affiliation(s)
- Ju-Yeun Lee
- Department of Ophthalmology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Jinu Han
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Mi Yang
- Statistics and Data Center, Samsung Medical Center, Seoul, South Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Eyre M, Hameed A, Wright S, Brownlee W, Ciccarelli O, Bowman R, Lim M, Wassmer E, Thompson D, Hemingway C, Hacohen Y. Retinal nerve fibre layer thinning is associated with worse visual outcome after optic neuritis in children with a relapsing demyelinating syndrome. Dev Med Child Neurol 2018; 60:1244-1250. [PMID: 29637998 DOI: 10.1111/dmcn.13757] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 12/26/2022]
Abstract
AIM Optic neuritis may be monophasic or occur as part of a relapsing demyelinating syndrome (RDS), such as multiple sclerosis, aquaporin-4 antibody (AQP4-Ab) neuromyelitis optical spectrum disorder (NMOSD), or myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease. The aims of this study were to test whether clinical, electrophysiological, and microstructural parameters differ in multiple-sclerosis-associated optic neuritis (MS-ON) and antibody-associated optic neuritis (Ab-ON); to identify the clinical and paraclinical characteristics of children suffering worse long-term visual outcome of RDS-optic neuritis; and to explore the relationship between RNFL thickness and clinical parameters in RDS-optic neuritis. METHOD Forty-two children with optic neuritis were retrospectively studied: 22 with multiple sclerosis (MS-ON) and 20 with antibody-associated demyelination (Ab-ON: MOG-Ab=16 and AQP4-Ab=4). Clinical and paraclinical features were analysed. RESULTS Complete recovery of visual acuity was reported in 25 out of 42 children; eight out of 38 (21%) suffered moderate or severe visual impairment (logarithm of the minimum angle of resolution [logMAR]>0.5) in their worse eye, including four out of 38 who were blind (logMAR>1.3) in their worse eye (two with multiple sclerosis, two with AQP4-Ab NMOSD). None of the children with MOG-Ab were blind. Recurrence of optic neuritis was more common in the Ab-ON group than the MS-ON group (15 out of 20 vs seven out of 22, p=0.007). Retinal nerve fibre layer (RNFL) thickness at baseline inversely correlated with visual acuity at final follow-up (r=-0.41, p=0.008). There was no significant relationship between the number of episodes of optic neuritis and mean RNFL (r=-0.08, p=0.628), nor any significant relationship between the number of episodes of optic neuritis and visual impairment (r=0.03, p=0.794). INTERPRETATION In children with RDS, long-term visual impairment inversely correlated with RNFL thickness, but not with the number of relapses of optic neuritis. Optical coherence tomography may have a role in assessing children with optic neuritis to monitor disease activity and inform treatment decisions. WHAT THIS PAPER ADDS Long-term visual impairment is reported in 40% of children with a relapsing demyelinating syndrome following optic neuritis. Relapse of optic neuritis, occurring more frequently in the non-multiple-sclerosis group. Retinal nerve fibre layer thinning is associated with worse visual outcome. Optical coherence tomography can be used alongside clinical parameters as an objective measure of neuroretinal loss.
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Affiliation(s)
- Michael Eyre
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Aasim Hameed
- The Clinical and Academic Department of Ophthalmology, Department of Paediatric Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Sukhvir Wright
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Wallace Brownlee
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK.,National Institute for Health Research, UCL Hospitals, Biomedical Research Centre, London, UK
| | - Richard Bowman
- The Clinical and Academic Department of Ophthalmology, Department of Paediatric Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK.,Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Dorothy Thompson
- The Clinical and Academic Department of Ophthalmology, Department of Paediatric Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK.,Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK
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Monge Galindo L, Martínez de Morentín AL, Pueyo Royo V, García Iñiguez JP, Sánchez Marco S, López-Pisón J, Peña-Segura JL. Optic neuritis in paediatric patients: Experience over 27 years and a management protocol. Neurologia 2018. [PMID: 29526320 DOI: 10.1016/j.nrl.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE In this article, we present our experience on optic neuritis (ON) and provide a diagnostic/therapeutic protocol, intended to rule out other aetiologies (particularly infection), and a fact sheet for parents. MATERIAL AND METHODS We conducted a descriptive, retrospective study of patients with ON over a 27-year period (1990-2017). A review of the available scientific evidence was performed in order to draft the protocol and fact sheet. RESULTS Our neuropaediatrics department has assessed 20,744 patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis (MS), 1 had clinically isolated syndrome (CIS), 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously. Patients' age range was 4-13 years; 50% were boys. Eight patients were aged over 10: 7 had isolated ON and 1 had MS. Nine patients had bilateral ON, and 3 had retrobulbar ON. MRI results were normal in 7 patients and showed involvement of the optic nerve only in 2 patients and optic nerve involvement + central nervous system demyelination in 5. Thirteen patients received corticosteroids. One patient had been vaccinated against meningococcus-C the previous month. Progression was favourable, except in the patient with MS. A management protocol and fact sheet are provided. CONCLUSIONS ON usually has a favourable clinical course. In children aged older than 10 years with risk factors for MS or optic neuromyelitis (hyperintensity on brain MRI, oligoclonal bands, anti-NMO antibody positivity, ON recurrence), the initiation of immunomodulatory treatment should be agreed with the neurology department. The protocol is useful for diagnostic decision-making, follow-up, and treatment of this rare disease with potentially major repercussions. The use of protocols and fact sheets is important.
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Affiliation(s)
- L Monge Galindo
- Sección de Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
| | | | - V Pueyo Royo
- Servicio de Oftalmología, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - J P García Iñiguez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - S Sánchez Marco
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - J López-Pisón
- Sección de Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - J L Peña-Segura
- Sección de Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
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17
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18
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19
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Khadse R, Ravindran M, Pawar N, Maharajan P, Rengappa R. Clinical profile and neuroimaging in pediatric optic neuritis in Indian population: A case series. Indian J Ophthalmol 2017; 65:242-245. [PMID: 28440255 PMCID: PMC5426131 DOI: 10.4103/ijo.ijo_939_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose of the study: The purpose of this study was to report clinical features, neuroimaging, and visual outcome in pediatric optic neuritis (ON) in Indian population. Materials and Methods: This is a retrospective study of children up to the age of 16 years, diagnosed with ON, that presented at pediatric and neuroophthalmology clinic of a tertiary eye care center, in South India, within the period of 2010–2015. Results: We identified 62 eyes of 40 children diagnosed as ON within the study period. The mean age was 11.15 ± 3.24 years (1–15 years) with mean follow-up of 13 months. In this series, there was female preponderance (67%). Mean logarithm of the minimum angle of resolution visual acuity at presentation was 1.14 ± 0.93, which after treatment recovered to 0.10 ± 0.26 at final visit (P < 0.001). Involvement was bilateral in 22 children (55%) and recurrent in 3 eyes of 3 children. Preceding febrile illness was reported in seven cases (18%). Four (10%) cases were diagnosed as multiple sclerosis (MS), one with neuromyelitis optica, and one with acute disseminated encephalomyelitis. One case was associated with tuberculous meningitis, 1 with septicemia, and 1 with bilateral maxillary sinusitis. Neuroimaging studies of optic nerve in 14 children demonstrated isolated optic nerve enhancement. Magnetic resonance imaging brain revealed white matter T2 hyperintense lesions separate from optic nerve in ten cases, of which four cases were diagnosed as MS. Conclusions: Bilateral presentation was common, association with MS was low. Papillitis was more frequent than retrobulbar neuritis and prognosis was good in pediatric ON in Indian population.
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Affiliation(s)
- Rutika Khadse
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Meenakshi Ravindran
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Neelam Pawar
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Padmavathy Maharajan
- Department of Neurophthalmology, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Ramakrishnan Rengappa
- Department of Neurophthalmology, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
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Hwang JY, Yoon HK, Lee JH, Yoon HM, Jung AY, Cho YA, Lee JS, Yoon CH. Cranial Nerve Disorders in Children: MR Imaging Findings. Radiographics 2017; 36:1178-94. [PMID: 27399242 DOI: 10.1148/rg.2016150163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cranial nerve disorders are uncommon disease conditions encountered in pediatric patients, and can be categorized as congenital, inflammatory, traumatic, or tumorous conditions that involve the cranial nerve itself or propagation of the disorder from adjacent organs. However, determination of the normal course, as well as abnormalities, of cranial nerves in pediatric patients is challenging because of the small caliber of the cranial nerve, as well as the small intracranial and skull base structures. With the help of recently developed magnetic resonance (MR) imaging techniques that provide higher spatial resolution and fast imaging techniques including three-dimensional MR images with or without the use of gadolinium contrast agent, radiologists can more easily diagnose disease conditions that involve the small cranial nerves, such as the oculomotor, abducens, facial, and hypoglossal nerves, as well as normal radiologic anatomy, even in very young children. If cranial nerve involvement is suspected, careful evaluation of the cranial nerves should include specific MR imaging protocols. Localization is an important consideration in cranial nerve imaging, and should cover entire pathways and target organs as much as possible. Therefore, radiologists should be familiar not only with the various diseases that cause cranial nerve dysfunction, and the entire course of each cranial nerve including the intra-axial nuclei and fibers, but also the technical considerations for optimal imaging of pediatric cranial nerves. In this article, we briefly review normal cranial nerve anatomy and imaging findings of various pediatric cranial nerve dysfunctions, as well as the technical considerations of pediatric cranial nerve imaging. Online supplemental material is available for this article. (©)RSNA, 2016.
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Affiliation(s)
- Jae-Yeon Hwang
- From the the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hye-Kyung Yoon
- From the the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- From the the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hee Mang Yoon
- From the the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ah Young Jung
- From the the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Ah Cho
- From the the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Seong Lee
- From the the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chong Hyun Yoon
- From the the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Kim YM, Kim HY, Cho MJ, Kwak MJ, Park KH, Yeon GM, Lee Y, Nam SO. Optic Neuritis in Korean Children: Low Risk of Subsequent Multiple Sclerosis. Pediatr Neurol 2015; 53:221-5. [PMID: 26183177 DOI: 10.1016/j.pediatrneurol.2015.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/20/2015] [Accepted: 05/22/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND A relationship between optic neuritis and multiple sclerosis has previously been reported in non-Asian adults. We extended the investigation to Korean children. OBJECTIVES We compared the clinical features, laboratory findings, and visual outcomes of optic neuritis between prepubertal children and postpubertal adolescents and evaluated the conversion rate of optic neuritis to multiple sclerosis in Korean children. METHODS We conducted a retrospective analysis of children less than 18 years of age presenting with optic neuritis at Pusan National University Hospital between January 2002 and December 2013. Outcomes and clinical, ophthalmologic, magnetic resonance imaging, and laboratory findings were reviewed. RESULTS Twenty-six children (male:female, 1:1.2) were included. Follow-up duration was 16.3 ± 27.5 months in the prepubertal children (≤10 years, n = 13) and 8.2 ± 9.2 months in postpubertal adolescent (>10 years, n = 13) (P = 0.32). There was no significant difference between the prepubertal group and postpubertal group in clinical, ophthalmologic, magnetic resonance imaging, or laboratory findings. Of two patients (7.7%) with abnormal brain magnetic resonance images, one developed multiple sclerosis and the other developed acute disseminated encephalomyelitis. Of three patients (11.5%) with relapsing optic neuritis, two developed systemic lupus erythematosus and one developed multiple sclerosis. CONCLUSION The risk of developing multiple sclerosis after pediatric optic neuritis was low (7.7%). Abnormal brain magnetic resonance imaging and relapsing optic neuritis should alert the clinician to systemic or neurological disorders.
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Affiliation(s)
- Young Mi Kim
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea.
| | - Hye Young Kim
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea
| | - Min Jeong Cho
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea
| | - Min Jung Kwak
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea
| | - Kyung Hee Park
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea
| | - Gyu Min Yeon
- Department of Pediatrics, Kosin University Hospital, Busan, Korea
| | - Yunjin Lee
- Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Yangsan, Korea
| | - Sang Ook Nam
- Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Yangsan, Korea
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Graves J, Kraus V, Soares BP, Hess CP, Waubant E. Longitudinally extensive optic neuritis in pediatric patients. J Child Neurol 2015; 30:120-3. [PMID: 24563470 DOI: 10.1177/0883073813520500] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extensive optic nerve demyelinating lesions on magnetic resonance imaging (MRI) in adults could indicate a diagnosis other than multiple sclerosis with worse prognosis such as neuromyelitis optica. We report the frequency of longitudinally extensive lesions in children with first events of optic neuritis. Subjects had brain or orbit MRI within 3 months of onset and were evaluated at the University of California, San Francisco, Pediatric Multiple Sclerosis Center. Lesion length, determined by T2 hyperintensity or contrast enhancement, was blindly graded as absent, focal or longitudinally extensive (at least 2 contiguous segments of optic nerve). Of 25 subjects, 9 (36%) had longitudinally extensive optic neuritis. Extensive lesions were not associated with non-multiple sclerosis versus multiple sclerosis diagnosis (P = 1.00). No association between age and lesion extent was observed (P = .26). Prospective studies are needed to determine if longitudinally extensive optic neuritis can predict visual outcome.
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Affiliation(s)
- Jennifer Graves
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Verena Kraus
- Department of Neuropediatrics, Children Hospital, Technische Universität, Munich, Germany
| | - Bruno P Soares
- Department of Radiology, University of California, San Francisco, CA, USA
| | - Christopher P Hess
- Department of Radiology, University of California, San Francisco, CA, USA
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, CA, USA
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23
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Balcer LJ, Miller DH, Reingold SC, Cohen JA. Vision and vision-related outcome measures in multiple sclerosis. Brain 2015; 138:11-27. [PMID: 25433914 PMCID: PMC4285195 DOI: 10.1093/brain/awu335] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/14/2014] [Accepted: 10/29/2014] [Indexed: 12/22/2022] Open
Abstract
Visual impairment is a key manifestation of multiple sclerosis. Acute optic neuritis is a common, often presenting manifestation, but visual deficits and structural loss of retinal axonal and neuronal integrity can occur even without a history of optic neuritis. Interest in vision in multiple sclerosis is growing, partially in response to the development of sensitive visual function tests, structural markers such as optical coherence tomography and magnetic resonance imaging, and quality of life measures that give clinical meaning to the structure-function correlations that are unique to the afferent visual pathway. Abnormal eye movements also are common in multiple sclerosis, but quantitative assessment methods that can be applied in practice and clinical trials are not readily available. We summarize here a comprehensive literature search and the discussion at a recent international meeting of investigators involved in the development and study of visual outcomes in multiple sclerosis, which had, as its overriding goals, to review the state of the field and identify areas for future research. We review data and principles to help us understand the importance of vision as a model for outcomes assessment in clinical practice and therapeutic trials in multiple sclerosis.
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Affiliation(s)
- Laura J Balcer
- 1 Departments of Neurology, Ophthalmology and Population Health, New York University School of Medicine, NY 10016, USA
| | - David H Miller
- 2 Queen Square MS Centre, UCL Institute of Neurology, London, WC1N 3BG, UK
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Wan MJ, Adebona O, Benson LA, Gorman MP, Heidary G. Visual outcomes in pediatric optic neuritis. Am J Ophthalmol 2014; 158:503-7.e2. [PMID: 24907434 DOI: 10.1016/j.ajo.2014.05.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the visual outcomes of a large cohort of pediatric patients presenting to a tertiary care pediatric hospital with first-episode optic neuritis. DESIGN Retrospective, observational cohort study. METHODS In a tertiary care pediatric hospital, patients with first-episode optic neuritis and at least 3 months of follow-up over a 10-year period were assessed and followed-up in the ophthalmology department. The main outcome measures were visual acuity at 3 months and 1 year of follow-up, with analysis of risk factors for poor visual outcomes and the time course of visual recovery. RESULTS Of the 59 pediatric patients with first-episode optic neuritis, 46 had at least 3 months of follow-up and 36 had at least 1 year of follow-up. The mean age was 12.6 years old; 72% were female, 41% had bilateral involvement, 52% had or developed an underlying diagnosis (39% multiple sclerosis, 7% acute disseminated encephalomyelitis, 7% neuromyelitis optica), and 91% received treatment (85% steroids, 7% multimodal). At 1 year, 81% were at least 20/20 and 89% were at least 20/40. A poor visual outcome at 1 year (<20/40) was associated with vision of <20/20 at 3 months (P = 0.041). Other clinical characteristics, including visual acuity at presentation, sex, bilateral involvement, optic nerve edema, and underlying diagnoses were not significantly associated with poor visual outcomes. CONCLUSIONS In this cohort of pediatric patients with optic neuritis, the majority of patients regained normal visual acuity at 1 year, regardless of baseline clinical characteristics.
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Affiliation(s)
- Michael J Wan
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Olumuyiwa Adebona
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leslie A Benson
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark P Gorman
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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Pérez-Cambrodí RJ, Gómez-Hurtado Cubillana A, Merino-Suárez ML, Piñero-Llorens DP, Laria-Ochaita C. Optic neuritis in pediatric population: a review in current tendencies of diagnosis and management. JOURNAL OF OPTOMETRY 2014; 7:125-130. [PMID: 25000867 PMCID: PMC4087179 DOI: 10.1016/j.optom.2013.12.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 09/23/2013] [Accepted: 09/23/2013] [Indexed: 06/03/2023]
Abstract
Optic neuritis is an inflammation of the optic nerve and may be related to different systemic conditions. The clinical presentation of this pathology usually includes sudden loss of visual acuity (VA) which may be unilateral or bilateral, visual field restriction, pain with eye movements, dyschromatopsia, a relative afferent pupillary defect and optic disk swelling. Optic neuritis in children has specific clinical features and a better prognosis than in adulthood. Although usually appears an underlying viral disease, the main concern for practitioners is the relationship of optic neuritis with multiple sclerosis. In addition to the classical techniques as magnetic resonance imaging (MRI), current tendencies of diagnosis for eye practitioners include new imaging devices as optical coherence tomography (OCT), useful to show a thinning of the retinal fibers layer (RFL) after the inflammatory episode. Regarding the management of these patients, short-term intravenous steroid dosages seem to be the best option to treat acute attacks characterized by a very poor bilateral VA.
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Affiliation(s)
| | | | - María L Merino-Suárez
- Oftalmar, Ophthalmology Department, Hospital Internacional Medimar, Alicante, Spain; Department of Optics, Anatomy and Pharmacology, University of Alicante, Spain
| | - David P Piñero-Llorens
- Oftalmar, Ophthalmology Department, Hospital Internacional Medimar, Alicante, Spain; Department of Optics, Anatomy and Pharmacology, University of Alicante, Spain
| | - Carlos Laria-Ochaita
- Oftalmar, Ophthalmology Department, Hospital Internacional Medimar, Alicante, Spain
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Kerrigan JF, Chrisman C, Rastogi RG. Unilateral visual loss in a previously healthy 15-year-old girl: monosymptomatic neuromyelitis optica? Semin Pediatr Neurol 2014; 21:145-51. [PMID: 25149951 DOI: 10.1016/j.spen.2014.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a previously healthy 15 year old girl with acute onset of unilateral visual loss consistent with a diagnosis of monosymptomatic optic neuritis. Her symptoms responded well to the use of high-dose intravenous methylprednisolone. With very brief follow-up (2 months) she has had no subsequent difficulties. However, testing was positive for the presence of anti-aquaporin-4 antibodies in both serum and cerebrospinal fluid, which have been associated with neuromyelitis optica (NMO). While NMO antibodies lack complete sensitivity, there is high degree of specificity. Our patient does not meet currently accepted diagnostic criteria for NMO, but is likely at high-risk to develop myelitis or recurrent optic neuritis. There are no evidence-based guidelines for whether this patient should undergo disease-modifying treatment. Based upon the high-risk for clinical relapse, we have recommended immunosuppressive therapy with rituximab (anti-B cell monoclonal antibodies). While randomized trials for patients with this clinical scenario are unlikely, observational studies of a cohort of such patients would provide better guidance on the natural history and merits of disease-modifying therapy.
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Affiliation(s)
- John F Kerrigan
- Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ.
| | - Christina Chrisman
- Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Reena Gogia Rastogi
- Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ
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İdiman E, Özakbaş S. The limited demyelinating diseases: the voyage of optic neuritis and transverse myelitis to multiple sclerosis and neuromyelitis. Expert Rev Neurother 2014. [DOI: 10.1586/ern.11.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Peche SS, Alshekhlee A, Kelly J, Lenox J, Mar S. A long-term follow-up study using IPMSSG criteria in children with CNS demyelination. Pediatr Neurol 2013; 49:329-34. [PMID: 23993834 DOI: 10.1016/j.pediatrneurol.2013.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 06/17/2013] [Accepted: 06/30/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the practical application of International Pediatrics Multiple Sclerosis study group definitions in children with inflammatory demyelination of the central nervous system and to identify predictors of multiple sclerosis. METHODS Baseline data on 123 children with a first episode of acute central nervous system demyelination were collected. The initial diagnosis according to the International Pediatrics Multiple Sclerosis study group was recorded and compared with final diagnosis. RESULTS Forty-seven (38.2%) children met International Pediatrics Multiple Sclerosis study group criteria for acute disseminated encephalomyelitis and 67 (54.4%) had clinically isolated syndrome at the initial presentation. Four (3.2%) had the diagnosis of neuromyelitis optica and five (4%) did not meet any specific diagnosis per the study group criteria. Clinical follow-up was available on 118 of 123 children (95.9%), with a median of 61.5 months (quartile range 23, 110 months). Conversion from clinically isolated syndrome to multiple sclerosis occurred in 26 of 67 children (38.8%); acute disseminated encephalomyelitis to multiple sclerosis occurred in 4 of 47 children (8.5%). Adjusted multivariate logistic regression analysis for an outcome of future development of multiple sclerosis showed the following predictors: female gender (odds ratio 12.44; 95% confidence interval 1.03-149.3); initial diagnosis of monofocal brain stem or hemispheric dysfunction (odds ratio 24.57; 95% confidence interval 3.06-196.78); and Callen magnetic resonance imaging criteria if met (odds ratio 122.45; 95% confidence interval 16.57-904.57). CONCLUSION International Pediatrics Multiple Sclerosis study group criteria affirm that children with initial clinically isolated syndrome are more likely to develop future multiple sclerosis compared with those with an acute disseminated encephalomyelitis initial diagnosis. In addition, female gender, brain stem or hemispheric involvement, and Callen magnetic resonance imaging criteria predict the diagnosis of multiple sclerosis.
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Affiliation(s)
- Shubhangi S Peche
- Department of Pediatrics, Division of Child and Adolescent Neurology, Southern Illinois University, Springfield, Illinois.
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29
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Williams SE, Edwards KM, Baxter RP, LaRussa PS, Halsey NA, Dekker CL, Vellozzi C, Marchant CD, Donofrio PD, Reimschisel TE, Berger M, Gidudu JF, Klein NP. Comprehensive assessment of serious adverse events following immunization by health care providers. J Pediatr 2013; 162:1276-81, 1281.e1. [PMID: 23452584 PMCID: PMC7125713 DOI: 10.1016/j.jpeds.2013.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 12/04/2012] [Accepted: 01/10/2013] [Indexed: 11/25/2022]
Affiliation(s)
- S. Elizabeth Williams
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center, Nashville, TN,Reprint requests: S. Elizabeth Williams, MD, Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center, 1161 21st Ave S, CCC 5326 MCN, Nashville, TN 37232-2573
| | - Kathryn M. Edwards
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center, Nashville, TN
| | | | - Philip S. LaRussa
- Division of Pediatric Infectious Diseases, Columbia University, New York City, NY
| | - Neal A. Halsey
- Department of International Health, Disease Prevention and Control Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Cornelia L. Dekker
- Division of Pediatric Infectious Diseases, Stanford University School of Medicine, Stanford, CA
| | - Claudia Vellozzi
- Immunization Safety Office, Division of Healthcare Quality and Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Peter D. Donofrio
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center, Nashville, TN
| | - Tyler E. Reimschisel
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center, Nashville, TN
| | - Melvin Berger
- Immunology Research and Development, CSL Behring LLC, King of Prussia, PA
| | - Jane F. Gidudu
- Immunization Safety Office, Division of Healthcare Quality and Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Heussinger N, Kontopantelis E, Rompel O, Paulides M, Trollmann R. Predicting multiple sclerosis following isolated optic neuritis in children. Eur J Neurol 2013; 20:1292-6. [DOI: 10.1111/ene.12184] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 03/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- N. Heussinger
- Department of Pediatrics; University Clinic of Erlangen-Nuremberg; Erlangen Germany
| | - E. Kontopantelis
- Institute of Population Health; University of Manchester; Manchester UK
| | - O. Rompel
- Department of Radiology; University Clinic of Erlangen-Nuremberg; Erlangen Germany
| | - M. Paulides
- Department of Pediatrics; University Clinic of Erlangen-Nuremberg; Erlangen Germany
| | - R. Trollmann
- Department of Pediatrics; University Clinic of Erlangen-Nuremberg; Erlangen Germany
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Pediatric multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2013. [PMID: 23622337 DOI: 10.1016/b978-0-444-52910-7.00049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Recognition of multiple sclerosis (MS) and other acquired demyelinating disorders in children has increased significantly in the last decade. Consensus definitions that characterize the varied clinical presentations of acute demyelination, and proposed clinical and MRI criteria specific for MS in children have aided diagnostic consistency. Care of children with an acute demyelinating attack is influenced by clinical severity, with corticosteroids, immunoglobulin, and plasma exchange being the most commonly employed therapies. Children with confirmed MS are often managed with immunomodulatory therapies (interferon and glatiramer acetate) approved for the treatment of MS in adults. Routine assessment of hepatic and hematological cell indices are important to monitor for safety of interferon therapy. While clinical treatment trials of interferon and glatiramer acetate in pediatric MS have yet to be conducted, case series evidence supports clinical safety and relapse rate reduction in the pediatric MS population. Epidemiological studies have implicated place of residence during childhood as a key determinant of MS risk. As such, pediatric-onset MS provides an opportunity to explore these risk factors contemporaneous with the clinical onset of disease. Studies of vitamin D, microbial exposures, and parental smoking are areas under active investigation. Finally, research exploring primary immunological mechanisms and host responses in patients with pediatric-onset MS, who by virtue of their young age may harbor fewer extraneous immune abnormalities, may yield new insights into the fundamental pathobiology of MS.
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Tantsis EM, Prelog K, Brilot F, Dale RC. Risk of multiple sclerosis after a first demyelinating syndrome in an Australian Paediatric cohort: clinical, radiological features and application of the McDonald 2010 MRI criteria. Mult Scler 2013; 19:1749-59. [DOI: 10.1177/1352458513484377] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The risk of multiple sclerosis (MS) is dependent on multiple variables, including geographical location. There is increasing interest in the early recognition and treatment of MS in children. Method: Using univariate and multivariate analysis, we determined the clinical and radiological features that were predictive of MS in 88 children from New South Wales, Australia, with a first acute demyelinating syndrome (ADS) who were followed for a minimum of one year. We tested the McDonald, KIDMUS, Callen and Verhey MRI criteria for paediatric MS. Results: After a mean follow-up of 5.2 years, 13/88 (15%) of children had MS. Using multivariate analysis, preceding infection was protective of MS, and corpus callosal lesions, the combined presence of both well and poorly demarcated lesions, and contrast-enhancing lesions on MRI were predictive of MS. The sensitivity and specificity of the respective radiological criteria were McDonald 2005 (69%, 68%), McDonald 2010 (58%, 95%), KIDMUS (8%, 100%), Callen (69%, 85%) and Verhey (62%, 84%). When McDonald 2010 criteria were applied to baseline and serial scans, the sensitivity and specificity was 91% and 93%. Conclusion: Despite the long follow-up, the risk of MS appears lower in New South Wales children compared to previously reported cohorts. Radiological features are more predictive than clinical features in predicting MS. The McDonald 2010 criteria performed well although the dissemination in time criteria on baseline scans is difficult to apply to children with encephalopathy.
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Affiliation(s)
- Esther M Tantsis
- Institute for Neuroscience and Muscle Research, The Children’s Hospital at Westmead, University of Sydney, Australia
| | - Kristina Prelog
- Department of Radiology, Children’s Hospital Westmead, Australia
| | - Fabienne Brilot
- Institute for Neuroscience and Muscle Research, The Children’s Hospital at Westmead, University of Sydney, Australia
| | - Russell C Dale
- Institute for Neuroscience and Muscle Research, The Children’s Hospital at Westmead, University of Sydney, Australia
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Abstract
OPINION STATEMENT Pediatric optic neuritis is a rare disorder causing a subacute loss of vision (often bilateral) in children, often of a severe degree. Common clinical findings include dense visual field loss, afferent pupillary defect (APD) in unilateral cases, and papillitis that is often bilateral. Contrary to optic neuritis in the adult population, the differential diagnosis for this disorder in pediatric patients is quite extensive, so neuroimaging and serologic evaluation are necessary to exclude an infectious or neoplastic process. Pediatric optic neuritis may occur as a clinically isolated syndrome, or in association with diffuse neurologic dysfunction, such as acute disseminated encephalomyelitis (ADEM). Optic neuritis may also be the first episode heralding the onset of pediatric multiple sclerosis or neuromyelitis optica (NMO or Devic's disease). Therefore, formal neurologic evaluation and follow-up are indicated. Although the management of this disorder in adults is well described, there is a paucity of evidence-based, prospective clinical data on its management and treatment in a pediatric population. The current treatment of pediatric optic neuritis consists of 3 to 5 days of intravenous methylprednisolone (4-30 mg/kg per day), followed by a prolonged oral corticosteroid taper. A prolonged course of oral steroid (2-4 weeks) is recommended to avoid recurrence, which is common in this age group. Some controversy persists concerning the exposure of children to high-dose parenteral corticosteroids to treat an entity that is usually self-limited, but given the severity of vision loss in one or both eyes in this population, this intervention is standard in neuro-ophthalmologic practice.
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Affiliation(s)
- Gabrielle R Bonhomme
- Eye and Ear Institute, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, 15213, USA,
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Affiliation(s)
- Mays A El-Dairi
- Department of Ophthalmology, Duke University Eye Center, DUMC 3802, Durham, NC 27710, USA
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35
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Waldman AT, Shumski MJ, Jerrehian M, Liu GT. Parent and medical professional willingness to enroll children in a hypothetical pediatric optic neuritis treatment trial. Front Neurol 2011; 2:75. [PMID: 22164153 PMCID: PMC3225801 DOI: 10.3389/fneur.2011.00075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 11/13/2011] [Indexed: 11/13/2022] Open
Abstract
The optic neuritis treatment trial (ONTT) and subsequent studies have had a tremendous impact on the treatment and prognosis of optic neuritis and multiple sclerosis in adults. The results of these studies have been extrapolated to children; however, pediatric data are sparse. Using the method of prospective preference assessment, the willingness of parents and medical professionals to enroll children in a hypothetical Pediatric ONTT was assessed using a mock consent form and questionnaire. A three-arm trial was proposed: (1) intravenous corticosteroids, (2) high-dose oral corticosteroids, and (3) an oral placebo. The forms were completed by 198 parents and 49 physicians. After reviewing the hypothetical scenario, trial design, risks and benefits, and alternatives to the study, 21% of parents would enroll their children in the trial whereas 98% of medical professionals would enroll their patients. With medical professional recommendation, 43% of parents would enroll their children. The manner in which this hypothetical trial was presented to parents, specifically with respect to the recommendation of their child's health care team, influenced a parent's willingness to participate.
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Affiliation(s)
- Amy T Waldman
- Division of Child Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA, USA
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36
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Subramanian PS. Pediatric optic neuritis and multiple sclerosis: who is at risk for progression? J AAPOS 2011; 15:419-20. [PMID: 21958904 DOI: 10.1016/j.jaapos.2011.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 06/25/2011] [Indexed: 10/17/2022]
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Waldman AT, Stull LB, Galetta SL, Balcer LJ, Liu GT. Pediatric optic neuritis and risk of multiple sclerosis: meta-analysis of observational studies. J AAPOS 2011; 15:441-6. [PMID: 22108356 DOI: 10.1016/j.jaapos.2011.05.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 05/07/2011] [Accepted: 05/18/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the relationships among age, unilateral versus bilateral simultaneous presentation, magnetic resonance imaging (MRI) lesions, and the risk of multiple sclerosis (MS) in children with optic neuritis. METHODS A systematic literature review and meta-analysis were performed by the use of a MEDLINE search to identify published studies containing individual patient data for children with optic neuritis. Age, laterality (unilateral vs bilateral simultaneous optic neuritis), presence of brain MRI abnormalities, and development of MS were recorded. Logistic regression was used to determine the relationships among these parameters. RESULTS Fourteen studies met inclusion criteria. Data for 223 patients (age range 2-17.8 years) were analyzed. Unilateral optic neuritis occurred more frequently in older children but was not associated with an increased risk of MS, after adjusting for age (odds ratio [OR] = 1.9, P = 0.11; 95% confidence interval [CI], 0.9-4.3). For every 1-year increase in age, the odds of developing MS increased by 32% (OR = 1.3, P = 0.005; 95% CI, 1.1-1.6, adjusted for the presence of MRI lesions). The risk of MS was greater in children with abnormal brain MRI scans at presentation compared with normal MRIs (OR = 28.0, P < 0.001, 95% CI, 6.3-125.1, adjusted for age). CONCLUSIONS The relationship between unilateral and bilateral optic neuritis and the development of MS is dependent on age. Older children and those with brain MRI abnormalities at presentation, are at greater risk for MS. Long-term follow-up of children with optic neuritis is needed to establish the true risk for the development of MS.
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Affiliation(s)
- Amy T Waldman
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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da Rocha AJ, Barros BRC, Guedes BVS, Maia ACM. Idiopathic inflammatory demyelinating disorders of the central nervous system in children. Top Magn Reson Imaging 2011; 22:223-237. [PMID: 24562092 DOI: 10.1097/rmr.0b013e3182972c03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Idiopathic inflammatory demyelinating disorders of the central nervous system usually present with a typical morphologic pattern in adults, with multiple sclerosis as the predominant disorder. However, the variety of disorders in children has an odd range of features that have piqued the interest of researchers. Information concerning this group of diseases, both in vivo and in different age groups, has particularly progressed with the advent of magnetic resonance imaging in the last few decades. In this article, we provide an overview of the applicability of imaging for idiopathic inflammatory demyelinating disorders of the central nervous system in children. In addition to pediatric multiple sclerosis, this review addresses other related disorders, such as acute disseminated encephalomyelitis, pediatric neuromyelitis optica, recurrent optic neuritis, and relapsing transverse myelitis.
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Affiliation(s)
- Antonio José da Rocha
- From the *Division of Neuroradiology, Santa Casa de Misericórdia de São Paulo; and †Division of Neuroradiology, Fleury Medicina e Saúde, São Paulo, Brazil
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Capo H, Repka MX, Edmond JC, Drack AV, Blumenfeld L, Siatkowski RM. Optic nerve abnormalities in children: a practical approach. J AAPOS 2011; 15:281-90. [PMID: 21683634 DOI: 10.1016/j.jaapos.2011.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 02/25/2011] [Accepted: 02/26/2011] [Indexed: 10/18/2022]
Abstract
Evaluation of children with optic nerve abnormalities is challenging. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, and genetic testing are helpful in the diagnosis and management of these patients. Importantly, many optic nerve problems are not isolated but occur in association with systemic and central nervous system anomalies. The ophthalmologist thus plays a critical role in recognizing patients who warrant systemic and neurologic assessment.
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Affiliation(s)
- Hilda Capo
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida 33136, USA.
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40
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Jo DH, Kim SJ, Chae JH, Yu YS. The clinical characteristics of optic neuritis in Korean children. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:116-20. [PMID: 21461224 PMCID: PMC3060388 DOI: 10.3341/kjo.2011.25.2.116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 07/27/2010] [Indexed: 11/30/2022] Open
Abstract
Purpose To study the clinical characteristics of optic neuritis in Korean children. Methods A retrospective review of the medical charts of 20 patients who were diagnosed with optic neuritis before age 10 was conducted in this study. Data were collected on the demographics, clinical features, use of intravenous corticosteroids, neuroimaging, and diagnosis of multiple sclerosis. Results The mean age at diagnosis was 6.5 ± 1.8 years (range, 3 to 9 years). Seventeen patients (85%) were female, and 13 patients (65%) exhibited bilateral diseases. Visual acuity had decreased to ≤20 / 200 in 16 of the 20 patients, and recovered to ≥20 / 40 in 16 of the 20 patients. The mean duration between the worst visual acuity and 20 / 40 was 2.30 ± 2.91 months. Intravenous corticosteroid treatment was performed in 15 patients and exerted a beneficial effect on the visual outcomes. Disc swelling was observed in 75.8% of the affected eyes. Multiple sclerosis was diagnosed in five patients with a mean follow-up period of 21.9 ± 20.3 months. The presence of lesions in brain magnetic resonance images was identified as the most significant factor with regards to the occurrence of multiple sclerosis. Conclusions In children with optic neuritis, a profound decrease in initial visual acuity and rapid recovery of visual acuity were confirmed. Corticosteroid treatment resulted in a beneficial effect on visual outcomes, but had no effect on the risk of multiple sclerosis.
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Affiliation(s)
- Dong Hyun Jo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
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Suppiej A, Gaspa G, Cappellari A, Toldo I, Battistella PA. The role of visual evoked potentials in the differential diagnosis of functional visual loss and optic neuritis in children. J Child Neurol 2011; 26:58-64. [PMID: 20587737 DOI: 10.1177/0883073810373947] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to determine whether visual evoked potentials can aid the diagnosis of functional visual loss and differentiate it from optic neuritis in children. The medical records and visual evoked potentials of 72 patients registered in the neurophysiological database of our Institution in the period 2000-2009, with diagnoses of functional visual loss or optic neuritis were reviewed retrospectively. In 61 children, visual evoked potentials confirmed the diagnosis: 49 functional visual loss and 12 optic neuritis. Visual evoked potentials were normal in all patients but 1 in the functional visual loss group, while all were abnormal in the optic neuritis group. Overlapping clinical features occurred between the 2 groups as well as prevalent severe visual loss, relative afferent pupillary defect, and papillitis in optic neuritis. Visual evoked potentials are of value in confirming clinical suspicion of functional visual loss, particularly when clinical overlap with optic neuritis occurs.
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Affiliation(s)
- Agnese Suppiej
- Department of Paediatrics, University of Padova, Padova, Italy.
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Abstract
A 4-year-old boy develops an insidious optic neuropathy, of unknown etiology, followed shortly thereafter by a focal patch of hair loss (biopsy proven-alopecia areata) on the back of his head. The temporal aspects of these findings suggest a common, likely inflammatory, etiology.
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Patel Y, Bhise V, Krupp L. Pediatric multiple sclerosis. Ann Indian Acad Neurol 2009; 12:238-45. [PMID: 20182571 PMCID: PMC2824951 DOI: 10.4103/0972-2327.58281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 07/27/2009] [Accepted: 07/22/2009] [Indexed: 11/04/2022] Open
Abstract
Pediatric multiple sclerosis (MS) represents a particular MS subgroup with unique diagnostic challenges and many unanswered questions. Due to the narrow window of environmental exposures and clinical disease expression, children with MS may represent a particularly important group to study to gain a better understanding of MS pathogenesis. Acute disseminated encephalomyelitis (ADEM) is more common in children than in adults, often making the differential diagnosis of MS, particularly a clinically isolated syndrome, quite difficult. Although both disorders represent acute inflammatory disorders of the central nervous system and have overlapping symptoms, ADEM is typically (not always) self-limiting. The presence of encephalopathy is much more characteristic of ADEM and may help in distinguishing between the two. Young children (under ten years old) with MS differ the most from adults. They have a lower frequency of oligoclonal bands in their cerebrospinal fluid and are less likely to have discrete lesions on MRI. Problems of cognitive dysfunction and psychosocial adjustment have particularly serious implications in both children and teenagers with MS. Increased awareness of these difficulties and interventions are needed. While clinical research on therapies to alter the disease course is limited, the available data fortunately suggests that disease-modifying therapy is well tolerated and likely to be effective. Ultimately, multinational research studies are necessary to advance our knowledge of the causes, symptoms, and treatment of pediatric MS and such collaborations are currently underway.
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Affiliation(s)
- Yashma Patel
- Department of Neurology. Stony Brook University Medical Center, Stony Brook, NY 11794 USA
| | - Vikram Bhise
- Department of Neurology. Stony Brook University Medical Center, Stony Brook, NY 11794 USA
| | - Lauren Krupp
- Department of Neurology. Stony Brook University Medical Center, Stony Brook, NY 11794 USA
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